Commonwealth of Massachusetts
Executive Office of Health and Human Services
Division of Medical Assistance
600 Washington Street
Boston, MA 02111
MassHealth
Mental Health Center Bulletin 25
April 2000
TO: Mental Health Centers Participating in MassHealth
FROM: Mark E. Reynolds, Acting Commissioner
RE: Prior Authorization for Sedative-Hypnotic Sleep Medications
Background
Insomnia is a sleep disorder that affects an estimated 60 million
Americans a year according to the National Sleep Foundation. While
many patients with insomnia may be treated effectively without the use of
drugs, some patients are more effectively treated with sedative,
sleep-hypnotic medication. In those instances where sleep-hypnotic
therapy is indicated, research findings indicate that many medications
stop working after several weeks of continued use. Use of the
medication, therefore, should be limited to a maximum of two to three
weeks.
In February 1995 the Division published Pharmacy Bulletin 49 requiring
prior authorization for all benzodiazepines when used beyond 120
continuous days. This bulletin amends Pharmacy Bulletin 49 by requiring
prior authorization, as further described below, only for those
benzodiazepines as well as non-benzodiazepine and barbiturate
medications that are FDA approved for the primary purpose of treating
insomnia.
Drugs Requiring Prior Authorization
All medications that are FDA-approved for treatment of insomnia, will require
written prior authorization on and after April 1, 2000. If granted, prior
authorization will be given for a maximum of 30 days. The Division will allow a
maximum of three 30-day prior authorizations per any consecutive 12-month
period. Any drug or combination of drugs in the following list, as well as any
new- to-the-market medications used for insomnia that may not be included in the
list, count toward the yearly limit.
Amobarbital/Secobarbital (Tuinal) Chloral Hydrate (Noctec)
Estazolam (ProSom) Ethchlorvynol (Placidyl)
Flurazepam (Dalmane) Pentobarbital (Nembutal)
Quazepam (Doral) Secobarbital (Seconal)
Temazepam (Restoril) Triazolam (Halcion)
Zaleplon (Sonata) Zolpidem (Ambien)
MassHealth
Mental Health Center Bulletin 25
April 2000
Page 2
Note
Benzodiazepines that are FDA approved for a primary purpose other than
the treatment of insomnia, such as diazepam, lorazepam, or alprazolam,
will no longer be subject to prior authorization.
Prior Authorization
The initial prescription request in a 12-month period, if for no more than a
30-day supply, may be made by the pharmacist by calling the Drug
Utilization Review Program. All subsequent requests must be made by
the prescriber in writing. The prescriber must complete a Request for
Prior Authorization form or submit a written request on letterhead
containing the information required in Subchapter 5 of your provider
manual. The request must include the name, address, and telephone
number of the pharmacy that will fill the prescription. Send or fax the
completed form or request on letterhead with the appropriate information
to the address listed below:
Drug Utilization Review Program
University of Massachusetts Medical School
11 Midstate Drive
Auburn, MA 01501
Fax: (508) 721-7138
Tel: (800) 745-7318
Questions
If you have any questions about the information in this bulletin, please
contact the Unisys Provider Services Department at (617) 628-4141 or
1-800-325-5231.